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McNabb KC, Bergman AJ, Patil A, Lowensen K, Mthimkhulu N, Budhathoki C, Perrin N, Farley JE. Travel distance to rifampicin-resistant tuberculosis treatment and its impact on loss to follow-up: the importance of continued RR-TB treatment decentralization in South Africa. BMC Public Health 2024; 24:578. [PMID: 38389038 PMCID: PMC10885440 DOI: 10.1186/s12889-024-17924-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Understanding why patients experience loss to follow-up (LTFU) is essential for TB control. This analysis examines the impact of travel distance to RR-TB treatment on LTFU, which has yet to be analyzed within South Africa. METHODS We retrospectively analyzed 1436 patients treated for RR-TB at ten South African public hospitals. We linked patients to their residential ward using data reported to NHLS and maps available from the Municipal Demarcation Board. Travel distance was calculated from each patient's ward centroid to their RR-TB treatment site using the georoute command in Stata. The relationship between LTFU and travel distance was modeled using multivariable logistic regression. RESULTS Among 1436 participants, 75.6% successfully completed treatment and 24.4% were LTFU. The median travel distance was 40.96 km (IQR: 17.12, 63.49). A travel distance > 60 km increased odds of LTFU by 91% (p = 0.001) when adjusting for HIV status, age, sex, education level, employment status, residential locale, treatment regimen, and treatment site. CONCLUSION People living in KwaZulu-Natal and Eastern Cape travel long distances to receive RR-TB care, placing them at increased risk for LTFU. Policies that bring RR-TB treatment closer to patients, such as further decentralization to PHCs, are necessary to improve RR-TB outcomes.
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Affiliation(s)
- Katherine C McNabb
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA.
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA.
| | - Alanna J Bergman
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Amita Patil
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Kelly Lowensen
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Nomusa Mthimkhulu
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Port Shepstone, Republic of South Africa
| | - Chakra Budhathoki
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Nancy Perrin
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA
| | - Jason E Farley
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
- Johns Hopkins TB Research Advancement Center, Baltimore, MD, USA
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Washington R, Ramanaik S, Kumarasamy K, Sreenivasa PB, Adepu R, Reddy RC, Shah A, Swamickan R, Maryala BK, Mukherjee A, Pujar A, Panibatla V, Lakkappa MH, Potty RS. A mixed methods evaluation of a differentiated care model piloted for TB care in south India. J Public Health Res 2023; 12:22799036231197176. [PMID: 37746516 PMCID: PMC10515523 DOI: 10.1177/22799036231197176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 07/30/2023] [Indexed: 09/26/2023] Open
Abstract
Background India's National TB Elimination Program emphasizes patient-centered care to improve TB treatment outcomes. We describe the lessons learned from the implementation of a differentiated care model for TB care among individuals diagnosed with active TB. Design and methods Used mixed methods to pilot the Differentiated Care Model. Community health workers (CHWs) conducted a risk and needs assessment among individuals who were recently began TB treatment. Individuals identified with specific factors that are associated with poor treatment adherence were provided education, counseling, and linked to treatment and support services. Examined changes in TB treatment outcomes between the two cohorts of individuals on TB treatment before and after the intervention. We used qualitative research methods to explore the experiences of patients, family members, and front-line TB workers with the implementation of the DCM pilot. Results The CHWs were adept at the identification of individuals with risks to non-adherence. However, only a few provided differentiated care, as envisioned. There was no significant change in the TB treatment outcomes between the two cohorts of patients examined. CHWs' ability to provide differentiated care on a scale was limited by the short duration of implementation, their inadequate skills to manage co-morbidities, and the suboptimal support at the field level. Conclusions It is feasible for a cadre of well-trained front-line workers, mentored and supported by counselors and doctors, to provide differentiated care to those at risk for unfavorable TB treatment outcomes. However, differentiated care must be implemented on a scale for a duration that allows a change from the conventional practice of front-line workers, in order to influence the outcomes of population-level TB treatment.
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Affiliation(s)
- Reynold Washington
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- St John’s Research Institute, Bengaluru, Karnataka, India
| | | | | | | | - Rajesham Adepu
- Office of the Joint Director (TB), Commissionerate of Health and Family Welfare, Hyderabad, Telangana, India
| | - Ramesh Chandra Reddy
- Office of the Joint Director (TB), Lady Willingdon State TB Centre, Bengaluru, Karnataka, India
| | - Amar Shah
- Tuberculosisi and Infectious Diseases Division, USAID/India, New Delhi, India
| | - Reuben Swamickan
- Tuberculosisi and Infectious Diseases Division, USAID/India, New Delhi, India
| | | | | | - Ashwini Pujar
- Karnataka Health Promotion Trust, Bengaluru, Karnataka, India
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Mesic A, Ishaq S, Khan WH, Mureed A, Mar HT, Khaing EE, Bermudez-Aza E, Rose L, Lynen L, Seddiq MK, Amirzada HK, Keus K, Decroo T. Person-centred care and short oral treatment for rifampicin-resistant tuberculosis improve retention in care in Kandahar, Afghanistan. Trop Med Int Health 2022; 27:207-215. [PMID: 34978748 PMCID: PMC9306566 DOI: 10.1111/tmi.13716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objectives To describe the effect of adaptations to a person‐centred care with short oral regimens on retention in care for rifampicin‐resistant TB (RR‐TB) in Kandahar province, Afghanistan. Methods The study included people with RR‐TB registered in the programme between 01 October 2016 and 18 April 2021. From 19 November 2019, the programme implemented a trial investigating the safety and effectiveness of short oral RR‐TB regimens. During the trial, person‐centred care was adapted. We included the data from people living with RR‐TB treated in the period before and after the care model was adapted and applied Kaplan‐Meier statistics to compare rates of retention in care. Results Of 236 patients registered in the RR‐TB programme, 146 (61.9%) were registered before and 90 (38.1%) after the model of care was adapted. Before adaptations enhancing person‐centred care, pre‐treatment attrition was 23.3% (n = 34/146), whilst under the adapted care model it was 5.6% (n = 5/90). Attrition on treatment was 22.3% (n = 25/112) before adaptations, whilst during the study period none of the participants were lost‐to‐follow‐up on treatment and 3.3% died (n = 3/90). Conclusions As person‐centred care delivery and treatment regimens were adapted to better fit‐specific contextual challenges and the needs of the target population, retention in care improved amongst people with RR‐TB in Kandahar, Afghanistan.
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Affiliation(s)
- Anita Mesic
- Médecins Sans Frontières, Amsterdam, The Netherlands.,Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | | | | | | | | | | | | | | | - Lutgarde Lynen
- Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | | | - Hashim Khan Amirzada
- National Tuberculosis Control Programme, Ministry of Public Health, Kabul, Afghanistan
| | - Kees Keus
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Tom Decroo
- Institute of Tropical Medicine Antwerp, Antwerp, Belgium.,Research Foundation Flanders, Brussels, Belgium
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Horter S, Stringer B, Gray N, Parpieva N, Safaev K, Tigay Z, Singh J, Achar J. Person-centred care in practice: perspectives from a short course regimen for multi-drug resistant tuberculosis in Karakalpakstan, Uzbekistan. BMC Infect Dis 2020; 20:675. [PMID: 32938422 PMCID: PMC7493896 DOI: 10.1186/s12879-020-05407-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/08/2020] [Indexed: 02/05/2023] Open
Abstract
Introduction Person-centred care, an internationally recognised priority, describes the involvement of people in their care and treatment decisions, and the consideration of their needs and priorities within service delivery. Clarity is required regarding how it may be implemented in practice within different contexts. The standard multi-drug resistant tuberculosis (MDR-TB) treatment regimen is lengthy, toxic and insufficiently effective. 2019 World Health Organisation guidelines include a shorter (9–11-month) regimen and recommend that people with MDR-TB be involved in the choice of treatment option. We examine the perspectives and experiences of people with MDR-TB and health-care workers (HCW) regarding person-centred care in an MDR-TB programme in Karakalpakstan, Uzbekistan, run by Médecins Sans Frontières and the Ministry of Health. Methods A qualitative study comprising 48 interviews with 24 people with MDR-TB and 20 HCW was conducted in June–July 2019. Participants were recruited purposively to include a range of treatment-taking experiences and professional positions. Interview data were analysed thematically using coding to identify emerging patterns, concepts, and categories relating to person-centred care, with Nvivo12. Results People with MDR-TB were unfamiliar with shared decision-making and felt uncomfortable taking responsibility for their treatment choice. HCW were viewed as having greater knowledge and expertise, and patients trusted HCW to act in their best interests, deferring the choice of appropriate treatment course to them. HCW had concerns about involving people in treatment choices, preferring that doctors made decisions. People with MDR-TB wanted to be involved in discussions about their treatment, and have their preference sought, and were comfortable choosing whether treatment was ambulatory or hospital-based. Participants felt it important that people with MDR-TB had knowledge and understanding about their treatment and disease, to foster their sense of preparedness and ownership for treatment. Involving people in their care was said to motivate sustained treatment-taking, and it appeared important to have evidence of treatment need and effect. Conclusions There is a preference for doctors choosing the treatment regimen, linked to shared decision-making unfamiliarity and practitioner-patient knowledge imbalance. Involving people in their care, through discussions, information, and preference-seeking could foster ownership and self-responsibility, supporting sustained engagement with treatment.
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Affiliation(s)
- Shona Horter
- Médecins Sans Frontières, Chancery Exchange, 10 Furnival Street, London, EC4A 1AB, UK.
| | - Beverley Stringer
- Médecins Sans Frontières, Chancery Exchange, 10 Furnival Street, London, EC4A 1AB, UK
| | - Nell Gray
- Médecins Sans Frontières, Chancery Exchange, 10 Furnival Street, London, EC4A 1AB, UK
| | - Nargiza Parpieva
- RSSPMCPh&P, Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan
| | - Khasan Safaev
- RSSPMCPh&P, Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan
| | - Zinaida Tigay
- Republican Phtiziology Hospital #2, Ministry of Health of Karakalpakstan, Nukus, Uzbekistan
| | | | - Jay Achar
- Médecins Sans Frontières, Chancery Exchange, 10 Furnival Street, London, EC4A 1AB, UK
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